Combination HIV prevention approaches, integrating behavioral, biomedical, and social components, have shown promise but remain under-evaluated in trans-specific contexts. This work aimed to compare the effectiveness of different HIV prevention strategies among transgender populations through a network meta-analysis. A systematic search was conducted through PRISMA-NMA 2020 across PubMed, SciELO, LILACS, and Science Direct (2000-2025) using descriptors related to HIV, combined prevention, and Transgender populations. Only original quantitative studies reporting effect measures of interventions were included, using the condom usage behavior as common comparator: A) Restrictive sexual behavior + Safer sex self-efficacy; B) Restrictive sexual behavior + Safe sex with a condom; C) Restrictive sexual behavior + Safe sex with a condom + Social Support. Mean, SD, SE and 95% CI were estimated, and interventions were ranked using SUCRA radial. Four studies and 9 interventions were included. The most effective strategy was safer receptive sex with transgender people (SUCRA 84.3%), followed by safer sex with non-transgender males (SUCRA 66.11%). Direct and indirect comparisons indicated that interventions promoting safer receptive sex practices among transgender individuals were more effective than those targeting condom use behavior alone. The inclusion of gender-specific content and social support appears to enhance the impact of prevention strategies.

Raute the last nomadic hunter-gatherer marginalized indigenous group face disproportionate and persistent barriers to reproductive health services, including family planning and safe abortion. The lack of the pre-existing population-level quantitative reproductive health data limits the ability of health authority to design cultural-sensitive health services. This census-based cross-sectional study enrolled all 192 eligible married women of reproductive age in the Raute community of Parshuram Municipality, Dadeldhura district, Sudurpaschim Province, Nepal. Data was collected through structured interviews, and analyzed in IBM SPSS version 16. Results showed more than half of participants (53.6%) currently used family planning, with injectable contraceptives being the most common method (42.7%), followed by female sterilization (33.0%) and implants (24.3%), while condom use was negligible at 1.0%. Among non-users (46.4%), 97.7% cited lack of interest as the primary reason. Knowledge of safe abortion services was reported by 61.5% of women, yet only 8.3% had ever accessed such services, and awareness of Nepal's national safe abortion policy was critically low (10.4%). The independent predictor of current family planning utilization in the adjusted logistic regression model was non-utilization of safe abortion services (AOR = 4.275; 95% CI: 1.145-15.954; p = 0.030), suggesting that contraceptive use and abortion service use represent alternative reproductive management strategies in this community. Younger age (≤30 years) and urban residence were significantly associated with safe abortion use in bivariate analysis but were attenuated after adjustment. These findings reveal critical gaps in reproductive method diversity, safe abortion policy literacy, and male partner engagement. Community-based mobile outreach tailored to nomadic movement patterns, legal literacy programs in the local language, and strategies to engage male partners are indicated as priorities; their design should be informed by qualitative, community-engaged research into the cultural and relational dynamics that a structured survey cannot capture.

Citizenship status confers rights and access to healthcare, yet little is known about how it impacts contraception use and type of method use. This study examined the role of citizenship status on contraceptive use among reproductive-aged (18-44 years), cis-gender Latinx and Asian and Pacific Islander (API) women. This study used the 2017-2020 waves of the California Health Interview Survey (CHIS). Inclusion criteria included cisgender, heterosexual Latinx and API women of reproductive age (18-44 years) who were at risk of becoming pregnant (N = 3,027). Participants were classified into the following categories based on their citizenship status: non-citizens without a green card, legal permanent residents (LPRs), naturalized citizens, and U.S.-born citizens. We conducted bivariate analyses using Pearson's chi-square tests and multivariable analyses using adjusted binomial logistic regressions to assess associations between citizenship status and use of any modern and reversible method of contraception and type of method used. Models were stratified by race/ethnicity. All analyses were weighted. Three-quarters (75.8%) of the sample were Latinx, 57.5% were U.S.-born citizens, 16.3% were naturalized citizens, 10.6% were LPRs, and 15.7% were non-citizens without a green card. There were no significant differences in the type of contraception method use by citizenship status among Latinx. Among API, naturalized citizens had lower odds of any use and condom use and naturalized citizens and U.S.-born citizens had higher odds of using pill or other hormonal methods and IUD or implant compared to non-citizens without a green card. This study makes important contributions in understanding the role of citizenship status as a social determinant of reproductive health for Latinx and API in California.

Youth experiencing homelessness (YEH) are at increased risk of HIV. Communication among social network members of YEH about sexual health has the potential to promote safer sex practices. We collected self-reported social network data from 731 YEH (age 14-26) accessing homeless youth services in Los Angeles, California, between 2016 and 2018. Multi-level dyadic network analysis was performed to examine the individual- and network-level characteristics associated with communication about condoms, pre-exposure prophylaxis (PrEP), HIV and HIV testing. YEH were significantly more likely to report talking to a social network member about PrEP if the youth was transgender (OR = 3.65, 95% CI 1.53-8.76) or had a gender-expansive identity (OR = 3.06, 95% CI 1.22-7.68). YEH were more likely to talk to a social network member about PrEP if that network member identified as a sexual minority (LGBQ+) (OR = 8.45, 95% CI 1.13-2.77). YEH were also more likely to talk to a romantic/sexual partner about condom use (OR = 5.86, 95% CI 1.25-2.33) or HIV testing (OR = 1.90, 95% CI 1.08-3.35). Study findings highlight opportunities for improving PrEP uptake among transgender and gender-expansive YEH and for emphasizing partner communications within future HIV prevention interventions for youth experiencing homelessness.

BackgroundFemale sex workers face high occupational exposure to human papillomavirus (HPV), but to our knowledge no molecular HPV genotyping data have been published for Papua, Indonesia, where cervical screening reaches few women. Non-16/18 genotypes account for a large share of HPV infection across Asia, relevant to vaccine policy. We aimed to measure high-risk HPV (HR-HPV) prevalence, describe the genotypes present, and identify factors associated with HR-HPV positivity among FSWs in Jayapura.MethodsIn this cross-sectional study, female sex workers attending a reproductive health centre in Jayapura, Papua, were recruited by consecutive sampling in August 2025. Cervical specimens were genotyped for HR-HPV with a real-time PCR assay distinguishing HPV16, HPV18 and a pooled channel covering 12 high-risk types. A structured questionnaire recorded age, duration of sex work, condom use, vaccination status, sexually transmitted infection history and sexual contact frequency. Candidate predictors were screened bivariately before multivariable logistic regression.ResultsOf 75 participants, 33 (44%; 95% CI 33-56) were HR-HPV positive. Of these, 30 (91%; 95% CI 76-98) carried at least one non-16/18 genotype, and only three were attributable to HPV16 or HPV18 alone. Three women (4%) reported prior HPV vaccination. After adjustment for sexual contact frequency, each additional year of age was associated with lower odds of HR-HPV positivity (adjusted odds ratio 0.928, 95% CI 0.871-0.990, p = 0.023). The association with sexual contact frequency was positive but not significant (1.322, 95% CI 0.986-1.773, p = 0.062). Condom use was associated bivariately but excluded from the final model owing to unstable estimates.ConclusionsHR-HPV infection is common among female sex workers in Papua and mostly involves non HPV16 and HPV18 genotypes, which the current quadrivalent national programme does not cover. These data support nonavalent vaccination and HPV-DNA screening for female sex workers, and make expanded screening in the general population a priority for provincial health authorities in Papua.

Pathways through which advocacy training enhances engagement in advocacy among persons living with HIV (PLWH) are not well understood. In a secondary analysis from a randomized controlled trial of a peer advocacy training intervention for PLWH, we examined mediators of intervention effects on HIV prevention advocacy (i.e., encouraging others to engage in HIV protective behaviors) across members of their social network. A sample of 210 PLWH (105 in each of the intervention and control arms) provided information about their advocacy to their social network members at baseline, and 6-, 12-, and 18-month follow-up. Repeated measures linear regressions showed that PLWH in the intervention group targeted more social network members with advocacy for HIV testing, condom use, pre-exposure prophylaxis (PrEP) use, HIV care, and ART use over the follow-up period compared to those in the control group. In path analysis that examined each mediator in a separate model, reduced internalized HIV stigma and increased HIV knowledge as measured at month 6, each fully mediated the intervention effect on HIV care advocacy; reduced stigma partially mediated the effects on advocacy targeting each of the other four HIV protective behaviors, while increased knowledge partially mediated effects on HIV testing, condom and PrEP use advocacy. Results were unchanged when examining the joint mediation of stigma and knowledge. HIV disclosure and advocacy self-efficacy had no mediating effect. These findings highlight the importance of helping PLWH to cope with HIV stigma and gain knowledge about basic facts and common misconceptions related to HIV, to propel their engagement in advocacy for multiple HIV protective behaviors within their social networks.The trial was registered 2021-10-18 (NCT05098015).

BACKGROUNDNeisseria gonorrhoeae (NG), the pathogen causing the sexually transmitted infection (STI) gonorrhoea, shows increasing antimicrobial resistance threatening recommended treatments.AIMWe examined temporal trends in antibiotic susceptibility of NG isolates in Germany and possible shifts in sexual networks.METHODSWe analysed annual data from the German antimicrobial resistance sentinel surveillance programme Go-Surv-AMR (2014-2023). Isolates were tested by E-test for phenotypic susceptibility to azithromycin (AZM), ceftriaxone (CRO) and ciprofloxacin (CIP) to determine minimum inhibitory concentrations (MIC). We described patient demographics and calculated MIC metrics by year, sex, age group and specimen type. We assessed differences in yearly MIC distributions using Kolmogorov-Smirnov tests and analysed temporal trends by fitting beta distributions to log-transformed MIC by antibiotic and epidemiological group.RESULTSWe collected 5,421 NG isolates from across Germany, primarily from males (n = 4,704) and from urethral specimens (n = 4,060). From 2016 to 2023, median AZM MIC nearly quadrupled in female and male isolates (0.12-0.45 mg/L). Median CRO MIC remained low overall (≤ 0.009 mg/L) but increased significantly in males in 2022-2023, especially in extragenital/screening isolates. Median CIP MIC increased (0.003-0.0057 mg/L), most pronounced in male extragenital/screening isolates.CONCLUSIONAcross the examined decade, NG showed subtle increases in MIC in extragenital/screening isolates from males, possibly reflecting decreasing antibiotic susceptibility in groups that regularly undergo STI screening. Rising AZM MIC suggests early spread of resistant strains. This highlights the need for continued surveillance, consistent susceptibility testing, targeted education for vulnerable groups, promotion of condom use, and potential vaccination.